Patient maintained alfentanil target-controlled infusion for analgesia during extracorporeal shock wave lithotripsy

Purpose

The purpose of this study was to determine whether alfentanil given by a pharmacokinetic-based target controlled infusion (TCI) system under patient control is a suitable analgesic technique for extracorporeal shock wave lithotripsy (ESWL).

Methods

The design was an open, unblinded, noncomparative, prospective study. Forty outpatients undergoing ESWL were given patient maintained alfentanil TCI. Pain, nausea and sedation were assessed every 300 shocks. Vital signs were recorded every three minutes, pulse oximetry and electrocardiography being monitored continuously. Blood alfentanil concentration was measured for comparison with the predicted value.

Results

Alfentanil consumption (median 1.34 mg, range 0.8–3.6) and measured levels following treatment (median 60 ng·ml^?1, range 15.6–134.3) varied widely. The precision of the TCI system and the median prediction error (bias) were both 49%. The median of pain scores recorded during treatment was 4 (range 0–8). The median respiration rate was 15 bpm (range 10–23), three patients required oxygen (SaO₂ < 92%) Cardiovascular measurements were stable and there was no excessive sedation. The incidence of nausea was 15%. All patients were ready for hospital discharge within one hour following treatment.

Conclusions

Patient maintained alfentanil TCI provides good analgesia for ESWL in the majority of patients with little sedation. Respiratory depression is uncommon but supplementary oxygen should be given prophylactically. There is considerable interindividual variation in demand for alfentanil indicating the usefulness of the patient control method. The TCI system underestimated alfentanil blood concentrations but this did not affect its clinical usefulness.     

Peripheral pulse pressure patterns in pregnancy hypertension

Maternal heart rate and pulse pressure patterns were examined in 30 hypertensive pregnant women using noninvasive methodology described previously. "Narrow" and "wide" pulse patterns were identified. Narrow cutaneous pulse pressure patterns, which are thought to be caused by vasoconstriction, were associated with lower birth weight infants (1870 +/- 983 versus 3225 +/- 838 g; P less than .001) and earlier deliveries (34.2 +/- 5.2 versus 37.9 +/- 2.8 weeks; P less than .05). The data suggest that these adjunctive maternal cardiovascular-system evaluation techniques may be useful in identifying patients at risk of adverse perinatal outcome by detecting vasospasm of the peripheral microcirculation.     

Correlation of cytochrome P450 (CYP) 1A2 activity using caffeine phenotyping and olanzapine disposition in healthy volunteers.

Olanzapine has previously been shown to have predominant metabolism by cytochrome (CYP) P450 1A2. Caffeine has been shown to provide an accurate phenotypic probe for measuring CYP1A2 activity. The purpose of this study is to determine if a significant correlation exists between olanzapine disposition and caffeine metabolic ratios. Subjects were phenotyped for CYP1A2 activity with caffeine probe methodology. After 200-mg caffeine administration, blood (4 h), saliva (6 and 10 h), and urine (8 h total) were collected for high-performance liquid chromatography (HPLC) analysis of caffeine and its metabolites.CYP1A2 activity was measured as plasma (PMR(4 h)), saliva (SMR(6 h) and SMR(10 h)), and three urinary metabolic (UMR1(8 h), UMR2(8 h), and UMR3(8 h)) ratios. Each of the 14 healthy nonsmokers (13 male) received a single 10 mg olanzapine dose after which blood was collected for HPLC determination of olanzapine concentrations at predose and at 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, 6, 8, 10, 12, 24, 48, 72, 96, and 120 h postdose. Olanzapine pharmacokinetic parameters in this study were similar to those previously published. All caffeine metabolic ratios (PMR(4 h), SMR(6 h), SMR(10 h), UMR1(8 h), and UMR2(8 h)) significantly correlated with each other (p <0.001) except for UMR3(8 h), which did not correlate. A significant correlation (p <0.05) was also found between olanzapine clearance and PMR(4 h) (r=0.701), SMR(6 h) (r=0.644), SMR(10 h) (r=0.701), UMR1(8 h) (r=0.745), and UMR2(8 h) (r=0.710). A negative correlation was observed between olanzapine clearance and UMR3(8 h) (r=-0.029, p=NS). A significant correlation was found between olanzapine clearance and various caffeine metabolic ratios. Interpatient variability in CYP1A2 activity may explain the wide interpatient variability in olanzapine disposition. Compounds that modulate CYP1A2 activity may be expected to alter olanzapine pharmacokinetics accordingly.     

HER2-targeted therapy reduces incidence and progression of midlife mammary tumors in female murine mammary tumor virus huHER2-transgenic mice.

PURPOSE: This study examined the effectiveness of early and prolonged mu4D5 (the murine form of trastuzumab/Herceptin) treatment in transgenic mice that overexpress human HER2 (huHER2), under the murine mammary tumor virus promoter, as a model of huHER2-overexpressing breast cancer. EXPERIMENTAL DESIGN: Mice were randomly assigned to one of three treatment groups and received i.p. injections from 17 weeks of age until either 52 weeks of age or morbidity. Fourteen mice received 100 mg/kg mu4D5, 14 mice received 100 mg/kg antiherpes simplex virus glycoprotein D control antibody, and 11 mice received a diluent control. RESULTS: High levels of huHER2 expression were detectable in mammary glands of young virgin founder mice. Mammary adenocarcinomas were frequently found in female founders and progeny at an average age of 28 weeks, with some progressing to metastatic disease. The incidence of mammary tumors was significantly reduced, and tumor growth inhibition was observed in mice receiving mu4D5 compared with control mice. In addition, Harderian gland neoplasms, highly associated with overexpression of huHER2 in this transgenic line, were entirely absent in the mu4D5 treatment group, indicating down-regulation of huHER2 in vivo activity. CONCLUSIONS: Early intervention with mu4D5 was of benefit in our transgenic mice at high risk for developing huHER2-overexpressing breast cancer. This study suggests a potential benefit of early treatment with Herceptin in HER2-positive primary breast cancer.     

Post-traumatic cervical dystonia: a distinct entity?

BACKGROUND/OBJECTIVE: The incidence of head/neck trauma preceding cervical dystonia (CD) has been reported to be 5-21%. There are few reports comparing the clinical characteristics of patients with and without a history of injury. Our aim was to compare the clinical characteristics of idiopathic CD (CD-I) to those with onset precipitated by trauma (CD-T). METHODS: We evaluated 114 consecutive patients with CD over a 9-month period. All patients were interviewed using a detailed questionnaire and had a neurological examination. Their clinical charts were also reviewed. RESULTS: Fourteen patients (12%) had mild head/neck injury within a year preceding the onset of CD. Between the two groups (CD-I and CD-T), the gender distribution (F:M of 3:2), family history of movement disorders (32% vs. 29%), the prevalence of gestes antagonistes (65% vs. 64%), and response to botulinum toxin were similar. There were non-specific trends, including an earlier age of onset (mean ages 43.3 vs. 37.6), higher prevalence of neck pain (86% vs. 100%), head tremor (67% vs. 79%), and dystonia in other body parts (23% vs. 36%) in CD-T. CONCLUSIONS: CD-I and CD-T are clinically similar. Trauma may be a triggering factor in CD but this was only supported by non-significant trends in its earlier age of onset.     

弧形切割吻合器在低位直肠癌治疗中的应用

目的 评价弧形切割吻合器在低位直肠癌保肛手术中的应用.方法 回顾分析2006年至2008年使用弧形切割吻合器行低位直肠癌保肛手术22例患者的临床资料.结果 22例行保肛手术,1例发生亚临床微小瘘,保守治疗痊愈,无吻合口出血,无局部复发,两例患者分别于术后12、14个月死亡.结论 弧形切割吻合器有利于低位直肠癌保肛手术的开展,可提高保肛率.     

金银花药材中抗呼吸道病毒感染的咖啡酰奎宁酸类成分的定量研究

目的:寻找金银花中的抗呼吸道病毒感染的成分,并进行定量研究。方法:采用各种柱层析和制备薄层层析等方法分离、细胞病变法进行抗病毒作用的研究,采用RP-HPLC方法进行定量方法的研究。结果:分离得到了13种咖啡酰奎宁酸类化合物和咖啡酸、咖啡酸甲酯,确认咖啡酰奎宁酸类成分具有较强的抗呼吸道病毒作用,并采用HPLC方法测定了金银花中的 6种咖啡酰奎宁酸类成分和咖啡酸的含量。结论:咖啡酰奎宁酸类成分为金银花中的有效成分,定量方法准确、重复性好。     

荨麻水溶性化学成分研究

 目的 研究荨麻的水溶性化学成分。方法 运用大孔树脂、聚酰胺柱色谱、硅胶柱色谱等方法对荨麻水溶性化学成分 进行分离;运用UV,IR,MS,NMR等方法进行结构鉴定。结果 从荨麻全草中分离并鉴定了7个化合物,分别为硝酸钾(potassi- um nitrate,Ⅰ)、异鼠李素(isorhamnetin,Ⅱ)、山柰酚-7-O-β-D-吡喃葡萄糖苷(kaempferol-7-O-β-D-glucopyranoside,Ⅲ)、槲皮素-7-O-β-D-吡喃葡萄糖苷(quercetin-7-O-β-D-glucopyranoside,Ⅳ)、异鼠李素-3-O-β-D-芸香糖苷(isorhamnetin-3-O-β-rutinoside,Ⅴ)、3,5-二 咖啡酰奎宁酸(3,5-di-O-caffeoylquinic acid,Ⅵ)、芦丁(rutin,Ⅶ)。结论 化合物Ⅱ-Ⅶ均为首次从荨麻中分得,其中Ⅳ,Ⅴ为首 次从荨麻属中分得。